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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274407132
Report Date: 08/08/2024
Date Signed: 08/20/2024 03:14:38 PM


Document Has Been Signed on 08/20/2024 03:14 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/19/2024 10:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

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**Amended report from a case management conducted on 8-8-24 to remove confidential name

On 8/8/24 at 3:30PM Licensing Program Analyst (LPA) Andrea Cortez conducted an unannounced case management inspection. LPA met with Licensee Maria Ramirez and explained purpose of today's inspection is to follow up on an incident reported on 8/5/24. LPA interviewed Licensee, obtained children's roster, and toured facility.

Licensee stated the incidents occurred in the playroom, living room, and backyard between July 26th and August 1st.

On 8/6 Licensee stated C1 attempted to bit C3 and C4 Licensee was able to stop the occurrence. Licensee is trying new tactics such as, separations, sitting down and talking with him, and if needed will call mom to pick him up.

When Licensee spoke with C1 father, he stated that C1's brother bit a child at preschool the same day.

Licensee has reported the biting to parents on both sides. However, C1's mother was a little bothered that Licensee reported incident to Licensing.

Licensee will continue to work with both children and their parents. In addition to, keeping notes with dates and times. LPA gave Licensee reading material "when a child bites" for reference.

Licensee said C2 last day is August 20th as he starts school.

No deficiencies cited. Exit interview conducted and report was reviewed with the Licensee Maria Ramirez.


A notice of site visit was given and must remain posted for 30 days
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Andrea CortezTELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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